Detection rate of clinically significant prostate cancer in magnetic resonance imaging and ultrasonography‐fusion transperineal targeted biopsy for lesions with a prostate imaging reporting and data system version 2 score of 3–5

Hakozaki, Yuji; Matsushima, Hisashi; Murata, Toshiki; Masuda, Tomoko; Hirai, Yoko; Oda, Mai; Kawauchi, Nobuo; Yokoyama, Munehiro; Kume, Haruki

doi:10.1111/iju.13842

Cited by 9 publications

(20 citation statements)

References 31 publications

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“…Our per lesion analysis confirmed previous findings with an increased CDR for PCA and csPCA in the peripheral zone than in the anterior or transitional zone [ 18 ]. When the cancer was upgraded or solely detected by SB, it was utmost attributed to adjacent sectors of MRI index lesion, making an argument for focal perilesional saturation biopsies (FSB) [ 19 , 20 ].…”

Section: Discussionsupporting

confidence: 91%

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

et al. 2022

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Purpose Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. Methods Two hundred and fifty-nine men with PI-RADS 3–5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. Results CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4–5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors. Conclusion SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.

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Section: Discussionsupporting

confidence: 91%

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

et al. 2022

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“…In our retrospective analysis, the detection rate of any PCa on mpMRI-positive cases was similar to the one observed by others [ 8 , 14 , 15 , 16 , 17 ]. Overall, PCa was detected more significantly in biopsy-naïve patients than in patients undergoing prior biopsy, while negative biopsies were more frequent in prior biopsy.…”

Section: Discussionsupporting

confidence: 90%

“…The ideal detection method for diagnosing csPCa should be minimally invasive, have fewer complications and provide a higher detection rate for diagnosis. In recent years, interest in the transperineal biopsy approach has been growing [ 14 , 15 , 16 , 17 ], as the benefit appears to be not only in terms of reduced complications but also in terms of cancer characterization [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Fulco

Chiaradia²,

Ascalone³

et al. 2021

Cancers

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The management of prostate biopsy in men with clinical suspicion of prostate cancer has changed in the last few years, especially with the introduction of imaging techniques, to overcome the low efficacy of risk stratification based on PSA levels. Here, we aimed to compare the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. To this end, we retrospectively analyzed 272 patients who underwent combined transperineal targeted and standard biopsy during the same session. The primary outcome was to compare the cancer detection rate between targeted and standard biopsy. The secondary outcome was to evaluate the added value of combined targeted and standard biopsy approach as compared to only targeted or standard biopsy. Results showed that a rate of 16.7% clinically significant tumors (International Society of Urological Pathology (ISUP) grade ≥ 2) would have been lost if only the standard biopsy had been used. The combined targeted and standard biopsy showed an added value of 10.3% and 9.9% in reducing the risk of prostate cancer missing after targeted or standard biopsy alone, respectively. The combined targeted and standard biopsy pathway is recommended to reduce the risk of missing clinically significant prostate cancer.

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“…The technique of targeted MP-MRI/TRUS fusion biopsy is of broad and current interest; it is supported by the joint consensus of the Society of Abdominal Radiology and the American Urological Association (36). The targeted biopsy of suspicious lesions in patients with PSA >4 ng/mL has also been successfully performed by many other clinical applications (37)(38)(39). But a considerable number of patients with PSA in the grey zone have undergone excessive intervention.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

Ding¹,

Wu²,

Song³

et al. 2020

Transl Androl Urol

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Background: Urologists face a dilemma when deciding whether prostate biopsy is required for patients with prostate-specific antigen (PSA) levels in the grey zone (4 to 10 ng/mL). Methods:We retrospectively analyzed data from consecutive patients with PSA levels in grey zone, who underwent targeted multiparametric magnetic resonance imaging (MP-MRI)/transrectal ultrasound (TRUS) fusion biopsy with elastography between November 2017 and December 2019 in our hospital. The patientse data including age, PSA, fPSA (free PSA), fPSA/PSA, PSA density (PSAD), prostate volume, elastography Q-analysis score (EQS), and prostate imaging-reporting and data system (PI-RADS) score were collected. The nomogram was built using logistic regression and the final cohort of patients was randomly divided into a training cohort (70%) and a validation cohort (30%) by R software. The models were evaluated by receiver operating characteristic curve (ROC) analysis and calibration curve analysis. The nomogram was constructed from the best model. Results: The final study cohort consisted of 155 patients (training cohort, 109 patients; validation cohort, 46 patients) with PSA in the grey zone, of which 36 patients were pathologically diagnosed with PCa. The EQS model, −EQS model, +EQS model were built. The +EQS model that consisted of fPSA/PSA, EQS, and PI-RADS score had the best PCa diagnostic accuracy (development and validation, 0.783 and 0.781) and probability score (development and validation, 0.939 vs. 0.622). The new nomogram based on this model was constructed, in which fPSA/PSA ratio had the largest impact, followed by PI-RADS and EQS.Conclusions: Elastography and pre-biopsy MP-MRI has clinical significance for patients with PSA in the grey zone. The new nomogram, which is based on pre biopsy data including serological analysis, PI-RADS score, and EQS, can be helpful for clinical decision-making to avoid unnecessary biopsy.

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Detection rate of clinically significant prostate cancer in magnetic resonance imaging and ultrasonography‐fusion transperineal targeted biopsy for lesions with a prostate imaging reporting and data system version 2 score of 3–5

Cited by 9 publications

References 31 publications

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

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